About the roleWe are looking for CSRs for a client in the Healthcare Industry. This role is on a REMOTE setup and follows a Night Shift Schedule. Salary pays up to 35K Package. Minimum requirement of at least 3 years of Healthcare experience in a BPO setup.Essential Duties and Responsibilities:Processes opportunities, such as verifying benefits, requesting authorization, & following up on auth-requests.Completes data fields within the system with insurance information needed for claim submission, start & end dates of authorization, and others.Prepares correspondence to insurance companies, Health Care Professionals (HCPs) & other affiliates on behalf of patients, such as authorization requests, appeals & letters of agreement.Clearly documents all correspondence in the company databases.Troubleshoots and seeks solutions to problems related to questions and concerns over authorization and claims.When other team members are absent or not available, provides backup coverage for their territories/insurance/state.Support education of team members on insurance verification, authorization, and claims.Analyze and investigate denied claims and find ways/resolution for payment.Do outbound calls to different insurance companies to confirm information, submit/validate an authorization or claim submission/denials.Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up and/or root cause resolution.Assumes and performs other duties as assigned.Required QualificationsSTRONG US HEALTHCARE COMPREHENSIONMust understand the intricacies of medical and pharmacy insurance coverage.Must know and understand the difference between HMO, PPO, EPO, Indemnity, POS, Home Plans and Host Plans and be able to clearly communicate that to a patient and or another caregiver or medical professional.Must understand different denial reasons and claim status.Must understand CPT/HCPC codes, ICD 10, claim forms.Ability to learn and retain the specific criteria and requirements for different insurance plan.STRONG COMPUTER AND PHONE SKILLSMust be able to create Word documents, work in Excel, use templates, use the internet, Outlook and work in a company created database.Must be pleasant and knowledgeable when speaking with insurance company representatives.Preferred Qualifications3 years of US HEALTHCARE experience; Authorization and billing experience or insurance collections preferred.Proven knowledge of and experience with ICD-9/10, HCPCS, and modifier coding.Outstanding interpersonal, verbal, and written communications skills required.Must be flexible and able to work in a fast-paced, heavy volume work environment.Demonstrated computer, prioritization, and time management skills.Experience working at insurance companies/payors or with medical device reimbursement for a start-up or new technology company or durable medical equipment setting is high desirable.Education and Experience RequirementsBachelors degree preferred.Language SkillsMust be able to communicate effectively in English.Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.Ability to write routine reports and correspondence.
4 months ago